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Disability and Medicare- Why do I have to wait 24 months?

What is Medicare?

Medicare is health insurance provided by the Federal Government. Medicare is primarily for workers who are 65 years or older, however, other disabled claimants, including those with end-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant) can also get Medicare.

According to the SSA, “Medicare has two parts. Part A is hospital insurance. Most people do not have to pay for Part A. Part B is medical insurance. Most people pay monthly for Part B.”

When do I get my Medicare benefits?

Many individuals, especially those who are unemployed, may need medical insurance. Many wonder what options are available to them, but unless you are elderly or disabled, Medicare is not available.

If you have been approved for Social Security Disability Insurance (SSDI) you will receive Medicare 24 months from the date of your disability, and given the five month waiting period for SSDI this means that even if you are approved for SSDI, you could wait as long as 29 months for medical coverage.

Why did the SSA create a Medicare waiting period?

There were several reasons the Medicare waiting period was implemented. One of the main ones I have seen stated online and from other sources is that years ago most workers had short and long term disability plans from their employers and many of them would get several months of medical coverage and would not need governmental Medicare benefits immediately. This reason is stated on the SSA website.

Another reason, which is probably more accurate now, is simply due to the cost savings of waiting two years to provide this costly benefit to SSDI applicants.

What happens to Medicare coverage if I return to work?

Frequently we get questions from SSDI recipients who want to return to work but who do not want to lose their Medicare coverage. According to the SSA, you may receive “at least 93 months of hospital and medical insurance after the trial work period as long as you still have a disabling impairment.”

The SSA will continue to provide Medicare for a time to the worker, even if they are performing substantial gainful activity so you can attempt to return to gainful employment but have the assurance that your medical costs will be covered.

Additionally, even after your premium free Medicare coverage is terminated because you continue to work at a substantial level you can purchase Medicare if you continue to be disabled but you are able to continue to work. This provision was added under the Ticket to Work and Work Incentives Act of 1999 and is part of the way the SSA is helping claimants return to work.

So to summarize, if you continue to have a disabling condition but you have returned to work under the SSA Trial Work Period you can continue to keep your Medicare coverage for at least 8 ½ years after you return to work. This timeframe includes your trial work period.

Questions about Medicare

If you have questions about this coverage, you can contact Medicare toll-free at 1-800-MEDICARE (1-800-633-4227) to speak to a Medicare Customer Service Representative.
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